Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model

Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model Chongming Huang, Linna Yu, Kunlong Deng, Xuemei Chen, Na Tang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8621894/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Apr, 2026 Read the published version in BMC Medical Education → Version 1 posted 12 You are reading this latest preprint version Abstract Introduction : Airports, as critical transportation hubs, present unique medical emergency scenarios characterized by high unpredictability, diverse and complex disease profiles, and a demand for multi-departmental coordination. These conditions impose specialized requirements on the core competencies of nursing staff in airport emergency centers. However, current research has predominantly focused on emergency care skills within hospital settings, resulting in a significant gap in the evaluation system for nursing competencies specifically tailored to international airport emergency contexts. Existing training and assessment programs often lack systematic and tiered competency indicators, leading to insufficiently targeted training content and difficulties in evaluating outcomes. Therefore, this study aims to develop a scientific, systematic, and measurable core competency indicator framework for nursing staff in airport emergency centers based on the Onion Model, to address the absence of standardized assessment tools in this field. Method : Based on a comprehensive literature review, we developed a preliminary set of core competency indicators for airport emergency center nursing according to the Onion Model. Subsequently, 17 experts participated in a two-round Delphi survey between June and December 2025 to refine and finalize the indicators and their respective weights. Data : The study data primarily included: • Quantitative rating data (using a 5-point Likert scale) and qualitative feedback from the two rounds of Delphi expert consultations. • Pairwise comparison matrix data required for the Analytic Hierarchy Process (AHP). • Statistical data for calculating expert engagement rate, authority index, consensus level, and degree of coordination, to validate the reliability of the methodology and the effectiveness of the results. Results : The response rate for the questionnaires was 100% in both Delphi rounds. The expert authority index reached 0.832, and Kendall’s coordination coefficients were 0.509, 0.415, and 0.413 across different levels (P < 0.005). Based on the Onion Model, the finalized core competency indicators for nursing in airport emergency centers comprised 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. This study established a scientific and reliable competency indicator framework, providing a theoretical reference for training nursing staff in airport emergency centers. Implication : This study innovatively applies the Onion Model to the specific context of emergency nursing, providing a theoretical framework and empirical evidence for understanding and analyzing nursing competency structures in specialized settings. It enriches research on nursing competency models. The developed indicator system can be directly applied to the recruitment, selection, targeted training curriculum design, performance assessment, and career development guidance of nursing staff in airport emergency centers. Onion Model Airport Emergency Center Core Competency of Nurses Indicator System Delphi Method 1. INTRODUCTION 1.1 Research background Airports function as distinctive transportation hubs where emergency medical services operate under conditions of high unpredictability, diverse clinical presentations, and a critical need for multi-departmental coordination. Ineffective emergency response in such settings may result in treatment delays, disorganized resource use, higher risks to patient safety, and subsequently, greater public health and economic costs [ 1 , 2 ] . Yet, current frameworks still fall short in evaluating nursing competencies specific to airport emergencies. Training remains largely unstructured, lacking clear tiered benchmarks, which leads to poorly tailored programs and difficulties in measuring outcomes. A scientifically grounded core competency system is therefore essential to improve the efficacy of emergency medical response at airports. 1.2 Research problem Given this context, no systematic and practical tool currently exists to guide the development, assessment, and management of nursing competencies in airport emergency centers. Reliance on generalized emergency protocols or subjective judgment fails to address the precise demands of this specialized setting. This study consequently aims to develop and validate a core competency indicator system tailored to nursing in international airport emergencies. Specifically, the research seeks to: Construct a hierarchical indicator framework based on the Onion Model, integrating knowledge, skills, attitudes, and values relevant to airport emergency nursing; Determine indicator weights through Delphi expert consensus and Analytic Hierarchy Process (AHP), enhancing the system’s measurability and practicality; Apply the system to address real-world issues such as: Personnel selection and deployment, by defining clear competency standards; Training program design, enabling stratified and targeted curricula instead of uniform approaches; Performance appraisal, supporting objective, periodic evaluation and data-informed management; Career development, helping nurses plan professional growth based on structured competency roadmaps. 1.3 Current Research Status Significant work has been done around core nursing competency models, with widespread use of theoretical frameworks such as competency models and the Onion Model. These have helped outline necessary knowledge, skills, and traits—especially in conventional settings like hospital emergency departments and ICUs [ 3 , 4 ] . Related assessment tools have also been developed [ 5 , 6 ] . Studies further agree on fundamental dimensions of nursing competency—such as clinical assessment, emergency intervention, communication, teamwork, and critical thinking—laying a foundation for training and evaluation [ 7 ] . 1.4 Gaps and Limitations in Existing Research When directed toward the distinct and complex pre-hospital environment of airport emergencies, current research exhibits notable shortcomings. First, prevailing nursing competency models and their assessment tools are chiefly designed for hospital-based care. Consequently, they frequently miss critical competencies unique to airport response, including initial triage and command during mass casualty incidents, rescue operations in confined airport spaces like aircraft cabins or runways, and effective coordination with diverse non-medical entities such as air traffic control and security personnel. Context-specific procedures for public health emergencies, such as infection control, are also often underrepresented. A dedicated research gap exists. Literature shows few attempts to systematically build a core competency indicator system for nursing teams within international airport medical centers. Available studies in aviation medicine or transport nursing typically concentrate on flight nurses’ specialized skills or in-flight equipment, rather than the comprehensive competency framework needed for ground-based airport emergency staff—encompassing prevention, response, management, and patient transport throughout the emergency process [ 8 , 9 ] . The lack of authoritative, detailed standards in this setting has practical consequences. Training, assessment, and management at airport emergency centers often fall back on generic guidelines or institutional experience. This reliance contributes to training that poorly matches actual airport scenarios, highly subjective competency evaluations, and an underdeveloped evidence base for guiding nurses’ professional growth [ 10 ] . 1.5 Research Objectives and Scope To bridge these gaps, this research sought to: Construct a core competency indicator system for airport emergency nursing based on the Onion Model, Establish relative indicator weights to enable quantifiable assessment, and Outline specific applications for the system in personnel selection, training, and performance evaluation. Methodologically, the study combined the Delphi technique for expert consensus with the Analytic Hierarchy Process (AHP) for weight determination. The scope was confined to developing a competency model for nursing teams in international airport emergency centers. Key limitations should be noted: the expert panel primarily comprised Chinese practitioners, which may affect the model’s international generalizability and warrants further validation. Moreover, the predictive validity and practical effectiveness of the indicator system require testing through subsequent empirical studies. Ultimately, this work produced a systematic model consisting of 4 first-level, 13 second-level, and 56 third-level indicators [ 11 ] . It offers a theoretical framework and practical tool for standardizing nursing competency development in airport emergencies—a model potentially adaptable to similar transport hubs like seaports or high-speed rail stations. 2. METHODS 2.1 Onion Model The Onion Model is a multi-level competency framework that conceptualizes an individual’s capabilities as three progressive layers: the outermost Knowledge and Skills layer, the middle Behavioral Performance layer, and the innermost Intrinsic Attributes layer. This model uses the metaphorical layers of an onion to illustrate the deep structure of competence, emphasizing that capability extends beyond surface-level, visible knowledge and skills to include concrete behavioral applications, and is fundamentally driven by internal attributes such as values, motivation, and personality traits. The Knowledge and Skills layer encompasses explicit content like professional knowledge and operational skills, forming the foundational and observable aspect of competence. The Behavioral Performance layer reflects the application of this knowledge and skill in practical work settings, demonstrated through abilities like communication, adaptability, and teamwork. The core Intrinsic Attributes layer focuses on an individual's psychological characteristics and value systems, which serve as the fundamental drivers for competency development. This theory underscores the dynamic, integrated, and multidimensional nature of competence, making it suitable for assessment in complex environments and aiding in the holistic understanding and cultivation of an individual's comprehensive competency structure. Through this layered framework, the Onion Model provides a theoretical basis for the systematic analysis and continuous improvement of nursing competencies, facilitating the construction of a scientific and rational competency evaluation system and promoting standardized, refined management within the nursing profession. To construct an Onion Model-based core competency indicator system for airport emergency center nurses, an expert panel was formed, consisting of 17 experts: 2 held senior clinical nursing titles, 5 were engaged in clinical nursing practice, 4 in nursing management, 6 in clinical medicine, and 2 in administration. The final framework was developed through an evidence-based approach and Delphi expert consultation. 2.2 Literature Review A comprehensive literature search was conducted in Chinese databases (CNKI, Wanfang Data, VIP) and English databases (Medline, PubMed, Web of Science). The search strategy employed keywords including "onion model," "airport emergency center," "nursing," "core competency," "competence," "indicator," and "framework." The search period spanned from the inception of each database to February 2024. The inclusion criteria were: ① literature in Chinese or English; ② all publication types were considered. The exclusion criterion was: unavailability of the full text. Based on the findings of this literature review, a preliminary draft of the Onion Model-based core competency evaluation indicators for airport emergency center nurses was constructed. 2.3 Expert Panel Meetings A research team of 10 experts reviewed the preliminary draft of the core competency indicators. Considering the unique clinical context of airports, the competency levels were restructured. For items in the draft that were contentious, Focus Group Discussions (FGDs) were organized. The "Scenario Anchoring Method" was employed, where experts provided modification suggestions based on real-world cases. Through a voting process, items with an agreement rate of ≥ 90% were retained, ultimately finalizing the content of the core competency system. 2.4 Delphi Phase 2.4.1 Delphi Technique Phase According to the standard requirements for expert selection in the Delphi technique, the panel typically comprises 15 to 50 individuals [ 12 ] , who should possess extensive professional knowledge and practical experience in the relevant field. For this study, fifteen experts were selected. The criteria for expert inclusion were as follows: being a healthcare professional engaged in work related to civilian airport emergency centers or familiar with the current status and development of the industry; having over 10 years of work experience in this field; holding an intermediate professional title or higher; voluntarily agreeing to participate in the study. The exclusion criterion was the failure to return the consultation questionnaire in a timely manner during the research period. 2.4.2 Expert Questionnaire The expert consultation questionnaire used in this phase consisted of four main sections: 1) the background, objectives, and research content of the study; 2) general demographic information of the experts; 3) the expert’s familiarity with the content of the survey and the basis for their evaluation of the items [ 13 ] ; and 4) a request for experts to rate the importance of each indicator using a 5-point Likert scale, where a score of 1 indicated “not important” and 5 indicated “very important.” Experts were also invited to provide suggestions for adding, removing, or modifying items in the remarks section. 2.4.3 Implementation of the Expert Consultation The expert consultation was conducted in June 2025. Questionnaires were distributed to the selected experts, who were reminded to provide feedback in a timely manner. Two rounds of Delphi expert consultation were carried out. The process was concluded when a high degree of consensus among the experts was achieved. 2.4.4Delphi Implementation Two Delphi rounds were conducted via email from June to September 2025, each lasting two weeks. After Round 1, we revised materials based on expert feedback. Retention criteria required indicators to simultaneously satisfy: (1) mean importance score > 3.5, (2) coefficient of variation 20%. 2.7 Ethical Considerations This study was approved by the ethics board of Guangdong Second Provincial General Hospital (Approval ID: 2025-KY-SQ-160). All ethical considerations were conducted following the Helsinki Declaration. Participants received full study information before each Delphi phase. All provided written informed consent, acknowledging voluntary participation and unrestricted withdrawal rights. Data were anonymized using identification numbers, and all information from participants who withdrew was irreversibly destroyed. No personally identifiable data will appear in publications. 2.8 Data Analysis Data entry and statistical analysis were performed using IBM SPSS Statistics 25.0. General characteristics of the experts were described using frequencies, percentages (%), and mean ± standard deviation. The response rate of the questionnaires was used to represent the enthusiasm coefficient of the experts. The authority degree of the experts (Cr) was determined by the judgment coefficient (Ca) and familiarity coefficient (Cs) [ 14 ] , The degree of consensus among the experts was assessed using Kendall’s coefficient of concordance (W) and the coefficient of variation (CV). In this study, the criteria for retaining indicators included a CV < 0.25 and a mean score ≥ 3.5. Finally, the Analytic Hierarchy Process (AHP) was applied to determine the weights of indicators at all levels based on their importance ratings [ 15 ] 。 3. RESULTS 3.1 Expert Demographic Profile A total of 17 experts participated in this study. The demographic characteristics were as follows: Age: 9 were 30–40 years old, 5 were 40–50 years old, and 3 were over 50 years old. Gender: 13 females and 4 males. Professional title: 15 held intermediate-level titles and 2 held associate senior titles. Education level: 16 held bachelor’s degrees and 1 held a master’s degree. Years of experience: 2 had less than 10 years, 9 had 10–20 years, and 6 had more than 20 years. Professional field: 6 were engaged in clinical medicine, 5 in clinical nursing, 4 in nursing management, and 2 in administrative management. Geographical distribution: 3 from Northeast China, 1 from North China, 6 from East China, 3 from South China, 2 from Southwest China, and 2 from Northwest China. 3.2 Expert Response Rates and Authority Coefficient Two rounds of expert consultation were conducted, with 17 questionnaires distributed in each round. All 17 experts returned completed questionnaires, resulting in a response rate of 100%. This indicates a high level of interest and active engagement among the experts in the research on core competencies for airport emergency nursing. The expert authority coefficient (Cr) was 0.8323, which consisted of a judgment coefficient (Ca) of 0.9235 and a familiarity coefficient (Cs) of 0.7412. These results demonstrate that the 17 experts possessed a high degree of authority and credibility in the field of airport emergency care. 3.3 Concentration and Coordination of Expert Opinions The coefficient of variation (CV) and Kendall’s coefficient of concordance (W) were used to assess the degree of divergence among expert ratings for each indicator and to evaluate the reliability of each round of scoring. Kendall’s W reflects the level of agreement among the 16 participating experts regarding the weights assigned to indicators at each level. Because calculating Kendall’s W can be complex, it was computed using SPSS software. W values range between 0 and 1; higher values indicate better agreement among experts, while lower values indicate poorer agreement. A P-value of less than 0.05, corresponding to the W value, suggests that the experts' ratings of the indicator system were statistically consistent. The ranges of the coefficient of variation and Kendall’s W for indicators across levels, based on the two rounds of expert consultation, are presented in Tables 1 and 2 , respectively. Table 1 Range of coefficient of variation and coordination coefficient in the first round of expert consultation Evaluation Level Coefficient of Variation (CV) Kendall's W Chi-square Value Degrees of Freedom P -value First-level 0-0.167 0.659 33.593 3 <0.001 Second-level 0.068–0.233 0.387 85.515 13 <0.001 Third-level 0.049–0.258 0.394 388.339 58 <0.001 Table 2 Range of coefficient of variation and coordination coefficient in the second round of expert consultation Evaluation Level Coefficient of Variation (CV) Kendall's W Chi-square Value Degrees of Freedom P -value First-level 0.068–0.225 0.509 25.96 3 <0.001 Second-level 0-0.248 0.415 84.619 12 <0.001 Third-level 0-0.239 0.413 371.889 53 <0.001 The specific feedback from the first round of expert consultation indicated that indicators with a coefficient of variation (CV) greater than 0.25 were removed. Deleted indicators : 1.4 Port infectious disease prevention and control; under aviation clinical medicine indicators — 1.6.1 Understanding of health maintenance for flight personnel, and 1.6.2 Familiarity with common first aid and prevention measures for flight personnel. Modified indicator : Indicator 1.1.4 “Assessment, judgment, and management of acute pain such as chest pain and abdominal pain” was revised to “Assessment, judgment, and management of acute pain”. Added indicator : 1.1.8 Recognition and emergency management of chest pain and stroke. After deliberation, the research team decided to approve the deletion of indicators 1.4, 1.6.1, and 1.6.2; the modification of indicator 1.1.4; and the addition of the new indicator. In the second round of consultation, the Kendall’s W values for the indicators ranged from 0.413 to 0.509, which were statistically significant (P < 0.001). The consistency of expert opinions improved compared to the first round, indicating good inter-rater reliability. The specific Kendall’s W values are presented in Table 2 . No further modifications were suggested by the experts in this round. Following this, the research team held discussions based on the feedback from both Delphi rounds and finalized the indicator system. This resulted in 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. The detailed evaluation indicator scheme is shown in Tables 3 – 5 . 3.4 Weighting Results Based on the expert consultation scores from the second round, the weights of the indicator system were determined. The first-level indicators were assigned the following weights: theoretical knowledge (0.489), professional skills (0.436), professional competence (0.082), and professional development (0.082). Detailed weights for the remaining levels of indicators are presented in Tables 3 – 5 . Table 3 Expert Consultation Results for First-Level Indicators First-Level Indicator Mean ± Standard Deviation Coefficient of Variation Weight 1. Theoretical knowledge 4.941 ± 0.243 0.049 0.489 2. Professional Skills 4.882 ± 0.332 0.068 0.346 3. Professional Competence 4.118 ± 0.928 0.225 0.082 4. Professional Development 4.118 ± 0.928 0.225 0.082 Table 4 Expert Consultation Results for Secondary Indicators Secondary Indicators Mean ± Standard Deviation Coefficient of Variation Weight 1.1 Care of Common Acute and Critical Illnesses 4.647 ± 0.606 0.131 0.185 1.2 Transport of Critically Ill Patients 4.941 ± 0.243 0.049 0.427 1.3 Emergency Management and Response in Disaster Rescue and Public Health Emergencies 4.765 ± 0.437 0.092 0.277 1.4 Occupational Protection Knowledge 3.941 ± 0.827 0.210 0.064 1.5 Aviation Clinical Medicine 3.882 ± 0.781 0.201 0.047 2.1 Emergency Skills Proficiency 5.000 ± 0.000 0.000 0.471 2.2 Emergency Skills for Disaster Rescue and Public Health Emergencies 4.647 ± 0.493 0.106 0.160 2.3Management Skills 3.706 ± 0.920 0.248 0.049 2.4 Communication and Coordination Skills 4.941 ± 0.243 0.049 0.321 3.1 Professional Ethics and Standards 4.000 ± 0.866 0.217 0.667 3.2 Professional Commitment and Affective Attributes 3.941 ± 0.659 0.167 0.333 4.1Teaching and Instruction 4.06 ± 0.827 0.204 0.750 4.2 Scientific Research 3.647 ± 0.786 0.216 0.250 Table 5 Expert Consultation Results for Tertiary Indicators Tertiary Indicators Mean ± Standard Deviation Coefficient of Variation Weight 1.1.1 Knowledge of the etiology and mechanisms, clinical assessment and diagnosis, emergency care, and specialized nursing for common acute and critical conditions across various body systems. 4.882 ± 0.332 0.068 0.167 1.1.2 Knowledge of the etiology and mechanisms, clinical assessment and evaluation, emergency care, and specialized nursing for shock. 4.941 ± 0.246 0.049 0.237 1.1.3 Knowledge of the etiology and mechanisms, clinical assessment and evaluation, and emergency nursing care for trauma. 4.882 ± 0.332 0.068 0.167 1.1.4 Assessment, evaluation, and management of acute pain. 4.294 ± 0.849 0.198 0.057 1.1.5 Knowledge of the etiology and mechanisms, clinical assessment and evaluation, emergency care, and specialized nursing for common acute and critical conditions in special populations (e.g., pregnant women, children). 3.588 ± 0.712 0.199 0.022 1.1.6 Emergency nursing care for acute poisoning and accidents. 3.824 ± 0.728 0.190 0.030 1.1.7 Knowledge of the actions, routes of administration, and reactions of common emergency medications. 4.471 ± 0.780 0.179 0.084 1.1.8 Recognition and emergency management of chest pain and stroke. 4.941 ± 0.243 0.049 0.237 1.2.1 Knowledge of safe intra-hospital transport procedures for critically ill patients, handover content, and contraindications for transport. 4.941 ± 0.243 0.049 0.800 1.2.2 Ability to correctly execute patient transport based on the patient's specific condition and clinical needs. 4.353 ± 0.786 0.181 0.200 1.3.1 Familiarity with the activation process of the airport-specific mass casualty incident emergency response plan. 4.941 ± 0.243 0.049 0.508 1.3.2 Understanding of airport-specific triage scenarios: Ability to perform rapid, safe, and efficient mass casualty triage in complex airport environments (e.g., gates, runways, baggage claim areas), considering evacuation routes, safe zone establishment, and collaboration with fire services, security, and ground handling. 3.706 ± 0.772 0.208 0.060 1.3.3 Familiarity with fundamental knowledge and skills in disaster nursing, including basic disaster concepts, essential disaster nursing knowledge, and principles of medical emergency response in disasters. 4.765 ± 0.562 0.118 0.343 1.3.4 Awareness of potential legal and ethical issues nurses may encounter during rescue operations. 3.824 ± 0.883 0.231 0.089 1.4.1 Mastery of infection prevention and control knowledge. 3.941 ± 0.899 0.228 0.193 1.4.2 Mastery of basic occupational protection knowledge. 3.706 ± 0.772 0.208 0.092 1.4.3 Mastery of standard precaution knowledge. 4.588 ± 0.618 0.135 0.578 1.4.4 Mastery of post-exposure management procedures. 3.882 ± 0.858 0.221 0.137 1.5.1 Familiarity with aviation physiology: Understanding the effects of barometric pressure changes (e.g., during takeoff/landing) on common medical conditions (e.g., pneumothorax, barotrauma, sinusitis, bowel gas expansion) and trauma, and their emergency management. 3.647 ± 0.862 0.236 0.200 1.5.2 Mastery of knowledge regarding the impact of the aircraft cabin environment (low humidity, low oxygen partial pressure, confined space, noise) on patient conditions and the specifics of performing medical interventions onboard. 4.177 ± 0.81 0.194 0.800 2.1.1 Proficiency in basic/common emergency rescue techniques: Hemostasis, bandaging, immobilization, transport, etc. 5.000 ± 0.000 0.000 0.302 2.1.2 Proficiency in Basic Life Support (BLS) and Advanced Life Support (ALS). 5.000 ± 0.000 0.000 0.302 2.1.3 Proficiency in insertion and maintenance techniques for commonly used medical tubes/lines. 4.059 ± 0.966 0.238 0.046 2.1.4 Proficiency in the operation and management of commonly used emergency equipment/devices. 4.824 ± 0.393 0.082 0.151 2.1.5 Proficiency in confined space rescue: Ability to manage medical emergencies onboard an aircraft. 4.882 ± 0.332 0.068 0.199 2.2.1 Proficiency in triage techniques. 4.941 ± 0.243 0.049 0.343 2.2.2 Proficiency in nuclear, biological, and chemical (NBC) decontamination techniques. 3.882 ± 0.928 0.239 0.059 2.2.3 Proficiency in providing on-site emergency care in disaster settings. 4.941 ± 0.243 0.049 0.343 2.2.4 Familiarity with psychological first aid for mass casualties: Ability to conduct initial psychological assessment and provide group psychological interventions for a large number of distressed passengers and crew. 3.765 ± 0.752 0.200 0.045 2.2.5 Familiarity with disinfection and isolation procedures: Ability to perform isolation and decontamination for common and special infectious diseases. 4.706 ± 0.588 0.125 0.210 2.3.1 Familiarity with the organization and operation of emergency response teams. 4.941 ± 0.243 0.049 0.462 2.3.2 Mastery of occupational hazards and protection in nursing. 3.824 ± 0.810 0.212 0.077 2.3.3 Familiarity with the application of nursing-sensitive quality indicators and continuous quality improvement in airport emergency care. 4.941 ± 0.243 0.049 0.462 2.4.1 Cross-cultural communication competence and cultural sensitivity: Understanding health beliefs, pain expression, and preferences regarding medical decisions (e.g., informed consent processes, family roles) across different cultural backgrounds to avoid treatment delays or complaints due to cultural misunderstandings. 3.765 ± 0.903 0.240 0.042 2.4.2 Multilingual foundation: At least proficient in English, preferably with basic medical terminology in other commonly used languages. Ability to effectively use translation tools. 3.824 ± 0.883 0.231 0.063 2.4.3 Non-verbal communication: Ability to skillfully use clear gestures, pictures, etc., for effective communication when language is a barrier. 4.059 ± 0.827 0.204 0.101 2.4.4 Emergency response and multi-agency coordination capability. 3.824 ± 0.728 0.190 0.063 2.4.5 Resource coordination: Ability to coordinate medical resources both within and outside the airport within a short timeframe. 4.941 ± 0.243 0.049 0.366 2.4.6 Diversion coordination: Ability to rapidly coordinate ground ambulance services, customs and border control, receiving hospitals, etc., to ensure seamless handover when a flight diverts to the local airport for medical reasons. 4.941 ± 0.243 0.049 0.366 3.1.1 Airline agreements: Understanding specific protocols and processes of different airlines regarding medical incident handling and cost responsibilities. 3.941 ± 0.827 0.210 0.166 3.1.2 Civil aviation regulations: Familiarity with international and national civil aviation regulations related to aviation medicine. 3.647 ± 0.862 0.236 0.065 3.1.3 Mandatory reporting: Mastery of mandatory reporting procedures and designated recipients for specific incidents (e.g., those involving aviation safety, infectious diseases, fatalities, certain special diseases). 3.706 ± 0.849 0.229 0.106 3.1.4 Mastery of airport emergency center work regulations, job responsibilities, and operational procedures. 4.941 ± 0.243 0.049 0.662 3.2.1 Possession of professional integrity and a spirit of dedication. 4.177 ± 0.810 0.194 0.179 3.2.2 Humanistic care: Ability to conduct nursing practice in accordance with relevant laws, regulations, and ethical requirements. Respecting patient rights and protecting patient privacy. 4.118 ± 0.928 0.225 0.113 3.2.3 Strong sense of responsibility, demonstrating initiative in assuming duties. 4.941 ± 0.243 0.049 0.709 4.1.1 Advanced training and continuing education. 4.765 ± 0.437 0.092 0.278 4.1.2 Instructional design ability: Mastery of various theoretical teaching methods and multimedia production skills. 4.177 ± 0.728 0.174 0.088 4.1.3 Specialized study. 4.529 ± 0.717 0.158 0.175 4.1.4 Clinical teaching and preceptorship ability. 4.882 ± 0.332 0.068 0.412 4.1.5 Self-directed learning ability. 3.824 ± 0.810 0.212 0.047 4.2.1 Clinical research capability. 4.941 ± 0.243 0.049 0.577 4.2.2 Knowledge and practical ability in evidence-based nursing. 4.824 ± 0.393 0.082 0.342 4.2.3 Patent development capability. 3.882 ± 0.858 0.221 0.81 4. Discussion 4.1 Scientificity and Innovativeness of the Indicator System Construction The Delphi method employed in this study is a well-established approach widely used in similar research contexts. The reliability of its results is generally evaluated based on three aspects: expert authority, expert consensus, and participation rate. These aspects were selected because they collectively reflect the expertise, agreement, and engagement of the expert panel. In this study, the overall response rate across both rounds of consultation was 100%, indicating a high level of participation. The expert authority coefficient, which measures the expertise level of the panel, was 0.8323 for both rounds—exceeding the threshold of 0.700. This high coefficient supports the reliability of the findings. The coefficients of variation (CV), which indicate the degree of dispersion in expert ratings, ranged from 0 to 0.258 in the first round and 0 to 0.248 in the second round. Additionally, Kendall’s W values for the different indicator levels ranged from 0.413 to 0.509, demonstrating a high degree of consensus and stability in expert opinions. These results further affirm the reliability of the study outcomes. The Onion Theory is a framework designed to analyze and improve core competencies in nursing professionals. It conceptualizes competencies across four layers: knowledge, skills, attitudes, and behaviors [ 16 ] . The knowledge layer emphasizes theoretical and medical expertise; the skills layer focuses on clinical operational capabilities; the attitude layer addresses professional values and ethics; and the behavior layer assesses workplace performance. The Onion Theory’s hierarchical structure represents a progressive model that provides a clear pathway to develop nursing competencies and improve nursing quality. Its systematic design accommodates complex operational environments and incorporates dynamic adjustment mechanisms to adapt to contextual changes. In the specific setting of airport emergency care, the theory facilitates the enhancement of cross-cultural communication skills, emergency decision-making abilities, and teamwork cohesion, thereby contributing to more efficient emergency response and strengthened collaborative performance [ 17 ] . Its innovative application highlights the multidimensional and adaptive nature of nursing competency frameworks. Particularly in culturally diverse environments such as airports, nursing staff can improve their communication competence by understanding varying cultural perspectives on medical services and health, thereby reducing potential misunderstandings and conflicts. Furthermore, through strengthened emergency decision-making and team collaboration—supported by simulation training and team exercises—nursing personnel demonstrate significantly improved performance under high-pressure conditions and greater teamwork efficiency [ 18 ] . 3.2 Practicality and Replicability of the Constructed Indicator System This study developed a core competency indicator system for nursing in airport emergency centers based on the "Onion Theory." The system is characterized by high practicality and broad replicability. These attributes ensure the system provides clear guidance for capacity building in airport emergency centers and serves as a valuable reference for medical security systems in similar facilities. Regarding practicality, the system demonstrates a high degree of contextual fit. Its construction strictly adhered to the "from surface to core" logic of the Onion Theory and was closely integrated with the distinctive environment of airports. This includes responding to mass casualty incidents, managing various injuries and illnesses, operating under intense time pressure, and collaborating across multiple departments. Consequently, each indicator directly addresses core needs in real-world operational contexts. For instance, indicators like "Knowledge of Aviation Medical Emergency Management" and "Inter-departmental (e.g., Security, Ground Services) Collaborative Emergency Response Capability" represent critical elements that distinguish airport emergency care from conventional pre-hospital or in-hospital emergency care. This approach aligns with the study by Kyong Hee Park et al [ 19 ] , which identified and integrated nurses' core competencies across multiple roles and responsibilities through systematic review and network analysis, optimizing the indicator structure to fit specific nursing contexts. In terms of structure and operability, the hierarchical "onion" framework provides a clear pathway for competency assessment and development [ 20 ] . Managers can utilize indicators from the "Knowledge and Skills Layer" for initial competency screening and standardized training. Indicators from the "Ability Layer" (e.g., on-site decision-making, adaptability) can inform the design of advanced drills and scenario simulations. Meanwhile, the "Attitude and Values Layer" (e.g., humanitarian care, team collaboration spirit) offers value-based guidance for organizational culture development and staff motivation. This stratified logic facilitates the targeted allocation of resources, development of training programs, and establishment of performance evaluation criteria. The foundational layer primarily encompasses general emergency care competencies, including Basic Life Support (BLS) and Advanced Life Support (ALS) skills. These are essential capabilities for all emergency nursing personnel [ 21 ] .This layered capacity-building model supports the comprehensive enhancement of the integrated emergency response capabilities of airport emergency nurses, thereby increasing their adaptability and responsiveness within the complex and dynamic airport emergency environment [ 22 ] . 5. Limitations Several limitations should be considered when interpreting the findings of this study. First, the expert panel, while demonstrating high authority and engagement, was primarily composed of professionals from specific regions and institutional backgrounds. Consequently, the incorporated perspectives may reflect context-specific factors, potentially affecting the generalizability of the competency framework across different healthcare systems or cultural settings. Second, the construction of the competency framework relied on the Delphi method and the theoretical structure of the Onion Model. Although rigorous, this process is inherently subjective and consensus-based, and the resulting indicators may be influenced by the panel's collective viewpoint rather than solely by empirical evidence. Third, this study presents a theoretical framework whose practical effectiveness, impact on training outcomes, and applicability in real-world airport emergency scenarios have not yet been empirically validated. Implementation or longitudinal assessment is needed to confirm these aspects. Finally, the framework focuses on core competencies from a nursing perspective and may not fully encompass all interdisciplinary collaborative skills required in complex airport emergency responses, such as coordination with aviation security, ground operations, and external emergency services. Future research should aim to apply and test this framework in diverse clinical and operational settings, to validate, refine, and expand its components. 6. Conclusion This study constructed a core competency indicator system for nursing staff in airport emergency centers using the Delphi method. The system comprises 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. The developed system demonstrates scientific rigor and practical applicability, as it is based on a methodologically sound approach and a comprehensive, rational indicator framework. These findings provide a scientific basis for developing targeted emergency training programs for nursing personnel in airport emergency centers. However, the selection of experts may have introduced regional biases, which represents a potential limitation of this study. Therefore, future research should focus on practical application and validation to further refine and improve the proposed framework. Declarations 6.1 AUTHOR CONTRIBUTIONS Guarantor of integrity: Chongming Huang, Kunlong Deng Study conception: Linna Yu Literature review: Xuemei Chen, Na Tang Data collection: Chongming Huang, Xuemei Chen Data analysis: Kunlong Deng, Jiaxin Liu Statistical analysis: Chongming Huang Manuscript drafting: Chongming Huang Manuscript revision: Linan Yu Manuscript approval: Kunlong Deng 6.2 FUNDING This study was supported by the Guangdong Provincial Medical Science and Technology Research Foundation (Grant No. C2025051). 6.3 Data availability The data that support the findings of this study are available from the corresponding author upon reasonable request. 6.4 Acknowledgements The authors would like to express their sincere gratitude to all the expert panel members who contributed their time and expertise to this Delphi study. We also extend our appreciation to the participating nurses and institutions for their valuable input and support. 6.5 Consent for publication All authors read and approved the final manuscript. 6.6 CONFLICT OF INTEREST STATEMENT The authors declare no conflicts of interest. 6.7 ETHICS STATEMENT The study protocol was approved by the ethics board of Guangdong Second Provincial General Hospital (Approval No. 2025-KY-SQ-160; Date: June 30, 2025). All ethical considerations were conducted following the Helsinki Declaration. All participants received written documentation outlining the research objectives and methodology prior to participating in the Delphi study. Voluntary participation was confirmed through signed informed consent forms. Participants were explicitly informed of their right to withdraw at any stage. All data were anonymized using unique identification codes, with personal information of non-participants immediately deleted. Any public reporting of results guarantees non-identifiability of individuals. 7 STUDY STATEMENT This study has completed the construction of core competency indicators for nursing staff in airport emergency centers based on the Onion Model. References ASANO MAKINOT, TAKUHIRO Y. International airport and emergency medical care [J]. J Nippon Med School = Nippon Ika Daigaku zasshi. 2002;69(2):185–91. DOVE, D B, DEL GUERCIO L R, STAHL W M, et al. A metropolitan airport disaster plan–coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation [J]. J trauma. 1982;22(7):550–9. Jing CC, Xing Q, Wei LL, et al. Construction of an evaluation index system for trauma care competency of emergency specialist nurses. Chin J Clin Nurs. 2024;16(6):362–366372. Tian Y, He TT, Yang MF, et al. Research on construction method of post competency model for ICU specialist nurses. Chin J Integr Tradit West Med Intensive Crit Care. 2018;25(4):408–12. CHEN, Y C. [Essential professional core competencies for nurses] [J]. Hu li za zhi J Nurs. 2010;57(5):12–7. MCLANE. A M. Core competencies of masters-prepared nurses [J]. Nurs Res. 1978;27(1):48–53. TOMCZYK B CALDERS, CUSSEN M E, et al. A Framework for Standardizing Emergency Nursing Education and Training Across a Regional Health Care System: Programming, Planning, and Development via International Collaboration [J]. J Emerg Nurs. 2022;48(1):104–16. Chen WW, Chen L, Fan RJ, et al. Construction of competency index system for flight nurses in air rescue. Chin Nurs Res. 2022;36(4):600–5. Zhao Z, Liu HJ, Xie YX, et al. Construction of core knowledge system for flight nurses' air ambulance service. Chin Nurs Manag. 2020;20(5):676–80. Zhang XX, He LX, Zhang L, et al. Investigation on first aid knowledge, attitude, practice and training needs among airport staff. Chin Nurs Manag. 2015;15(12):1449–52. Wang X, Cui XM. Construction of an evaluation index system for independent duty qualification of newly recruited nurses in obstetrics department of tertiary hospitals based on Onion Model. J Nurs. 2024;31(21):32–8. Ding JF, Tan LF, Tang ZX, et al. Delphi method and its application in public health: current status and prospects. J Environ Occup Med. 2012;29(11):727–30. Li YY, Chen WJ. Application status of Delphi method in nursing management. Chin Nurs Res. 2018;32(21):3339–41. Wang SN, Dong R, Xie H, et al. Application progress of Delphi method in constructing indicator systems. J Bengbu Med Coll. 2016;41(5):695–8. Gong WY. Construction and predictive effect analysis of postpartum venous thromboembolism risk assessment scale based on Delphi-AHP method [Dissertation]. 2020. Zhang X, Wang XM. Construction of competency evaluation index system for nurses responding to public health emergencies in tertiary hospitals based on Onion Model. Gen J Nurs. 2025;23(12):2342–6. SHEKHAR, A C, RUSKIN K J. Sudden cardiac arrest in commercial airports: Incidence, responses, and implications [J]. Am J Emerg Med. 2022;59:118–20. D'ASTA F, HOMSI J, SFORZI I, et al. SIMBurns: A high-fidelity simulation program in emergency burn management developed through international collaboration [J]. Burns: J Int Soc Burn Injuries. 2019;45(1):120–7. PARK K H KIMHR. Mapping Nursing Roles in Long-Term Care: A Systematic Review With Network Analysis [J]. Journal of advanced nursing; 2025. LI CHENF, LI L et al. J,. Development of Infectious Disease Emergency Response Competencies for Nurses in China: A Delphi Study and an Analytic Hierarchy Process [J]. Journal of nursing management, 2023, 2023: 9952280. ADELGAIS LYNGJ, ALTER K. Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement [J]. Prehospital Emerg care. 2021;25(3):451–9. JIANG TAOY, LI X. An Evaluation Index System for Core Competencies of Specialist Nurses in Pediatric Emergency Care [J]. Am J Health Behav. 2023;47(2):217–27. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 10 Apr, 2026 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 18 Feb, 2026 Reviews received at journal 16 Feb, 2026 Reviewers agreed at journal 04 Feb, 2026 Reviews received at journal 03 Feb, 2026 Reviews received at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers agreed at journal 03 Feb, 2026 Reviewers invited by journal 03 Feb, 2026 Editor invited by journal 29 Jan, 2026 Editor assigned by journal 21 Jan, 2026 Submission checks completed at journal 21 Jan, 2026 First submitted to journal 16 Jan, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8621894","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":586532139,"identity":"0656408d-5dfc-4a77-8ffb-d63e9914da4a","order_by":0,"name":"Chongming Huang","email":"","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Chongming","middleName":"","lastName":"Huang","suffix":""},{"id":586532140,"identity":"c330bade-b813-4619-be07-aab9217a6cb1","order_by":1,"name":"Linna Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBACPmYwZSPHz97Y+OADMVrYIFrSjCV7DjcbziBKC4Q6nLjhRnqbNAdRWth5jz34uQOo5ebDBmkGBjs53QaCDuNLN+w9k24883Zig3EBQ7Kx2QGCWnjMJHjbrGX7gFqSZzAcSNxGjBbJv23MjA03DzYc5iFWizRvm7PihBuMjc3Ea5FtAwVyYjPjDAMi/MLPf8ZM8m0bKCqPP//xocJOjqAWNGBAmvJRMApGwSgYBTgAADRzPeMqTPreAAAAAElFTkSuQmCC","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":true,"prefix":"","firstName":"Linna","middleName":"","lastName":"Yu","suffix":""},{"id":586532141,"identity":"6406f12f-ddc0-4545-ab55-ef0bd7941de2","order_by":2,"name":"Kunlong Deng","email":"","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Kunlong","middleName":"","lastName":"Deng","suffix":""},{"id":586532142,"identity":"05d391a5-b899-4476-b5aa-ede65f70c6f5","order_by":3,"name":"Xuemei Chen","email":"","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Xuemei","middleName":"","lastName":"Chen","suffix":""},{"id":586532143,"identity":"c8052318-856b-4b1f-af39-d910c01b3562","order_by":4,"name":"Na Tang","email":"","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Tang","suffix":""},{"id":586532144,"identity":"b3b660bd-aa02-4add-8655-f66f5720f8c2","order_by":5,"name":"Jiaxin Liu","email":"","orcid":"","institution":"The Affiliated Guangdong Second Provincial General Hospital of Jinan University","correspondingAuthor":false,"prefix":"","firstName":"Jiaxin","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2026-01-16 19:53:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8621894/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8621894/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-026-09172-0","type":"published","date":"2026-04-10T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":106809103,"identity":"b81e6982-b56f-4583-929c-9bf8ae3868be","added_by":"auto","created_at":"2026-04-13 16:06:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1357379,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8621894/v1/4a2e9b06-1a80-4db8-a761-eb3f19054725.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Research background\u003c/h2\u003e \u003cp\u003eAirports function as distinctive transportation hubs where emergency medical services operate under conditions of high unpredictability, diverse clinical presentations, and a critical need for multi-departmental coordination. Ineffective emergency response in such settings may result in treatment delays, disorganized resource use, higher risks to patient safety, and subsequently, greater public health and economic costs \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Yet, current frameworks still fall short in evaluating nursing competencies specific to airport emergencies. Training remains largely unstructured, lacking clear tiered benchmarks, which leads to poorly tailored programs and difficulties in measuring outcomes. A scientifically grounded core competency system is therefore essential to improve the efficacy of emergency medical response at airports.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Research problem\u003c/h2\u003e \u003cp\u003eGiven this context, no systematic and practical tool currently exists to guide the development, assessment, and management of nursing competencies in airport emergency centers. Reliance on generalized emergency protocols or subjective judgment fails to address the precise demands of this specialized setting.\u003c/p\u003e \u003cp\u003eThis study consequently aims to develop and validate a core competency indicator system tailored to nursing in international airport emergencies. Specifically, the research seeks to:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConstruct a hierarchical indicator framework based on the Onion Model, integrating knowledge, skills, attitudes, and values relevant to airport emergency nursing;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDetermine indicator weights through Delphi expert consensus and Analytic Hierarchy Process (AHP), enhancing the system\u0026rsquo;s measurability and practicality;\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eApply the system to address real-world issues such as:\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePersonnel selection and deployment, by defining clear competency standards;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eTraining program design, enabling stratified and targeted curricula instead of uniform approaches;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePerformance appraisal, supporting objective, periodic evaluation and data-informed management;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCareer development, helping nurses plan professional growth based on structured competency roadmaps.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Current Research Status\u003c/h2\u003e \u003cp\u003eSignificant work has been done around core nursing competency models, with widespread use of theoretical frameworks such as competency models and the Onion Model. These have helped outline necessary knowledge, skills, and traits\u0026mdash;especially in conventional settings like hospital emergency departments and ICUs \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Related assessment tools have also been developed \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Studies further agree on fundamental dimensions of nursing competency\u0026mdash;such as clinical assessment, emergency intervention, communication, teamwork, and critical thinking\u0026mdash;laying a foundation for training and evaluation \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Gaps and Limitations in Existing Research\u003c/h2\u003e \u003cp\u003eWhen directed toward the distinct and complex pre-hospital environment of airport emergencies, current research exhibits notable shortcomings. First, prevailing nursing competency models and their assessment tools are chiefly designed for hospital-based care. Consequently, they frequently miss critical competencies unique to airport response, including initial triage and command during mass casualty incidents, rescue operations in confined airport spaces like aircraft cabins or runways, and effective coordination with diverse non-medical entities such as air traffic control and security personnel. Context-specific procedures for public health emergencies, such as infection control, are also often underrepresented.\u003c/p\u003e \u003cp\u003eA dedicated research gap exists. Literature shows few attempts to systematically build a core competency indicator system for nursing teams within international airport medical centers. Available studies in aviation medicine or transport nursing typically concentrate on flight nurses\u0026rsquo; specialized skills or in-flight equipment, rather than the comprehensive competency framework needed for ground-based airport emergency staff\u0026mdash;encompassing prevention, response, management, and patient transport throughout the emergency process \u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe lack of authoritative, detailed standards in this setting has practical consequences. Training, assessment, and management at airport emergency centers often fall back on generic guidelines or institutional experience. This reliance contributes to training that poorly matches actual airport scenarios, highly subjective competency evaluations, and an underdeveloped evidence base for guiding nurses\u0026rsquo; professional growth \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Research Objectives and Scope\u003c/h2\u003e \u003cp\u003eTo bridge these gaps, this research sought to:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eConstruct a core competency indicator system for airport emergency nursing based on the Onion Model,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEstablish relative indicator weights to enable quantifiable assessment, and\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOutline specific applications for the system in personnel selection, training, and performance evaluation.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eMethodologically, the study combined the Delphi technique for expert consensus with the Analytic Hierarchy Process (AHP) for weight determination.\u003c/p\u003e \u003cp\u003eThe scope was confined to developing a competency model for nursing teams in international airport emergency centers. Key limitations should be noted: the expert panel primarily comprised Chinese practitioners, which may affect the model\u0026rsquo;s international generalizability and warrants further validation. Moreover, the predictive validity and practical effectiveness of the indicator system require testing through subsequent empirical studies.\u003c/p\u003e \u003cp\u003eUltimately, this work produced a systematic model consisting of 4 first-level, 13 second-level, and 56 third-level indicators \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. It offers a theoretical framework and practical tool for standardizing nursing competency development in airport emergencies\u0026mdash;a model potentially adaptable to similar transport hubs like seaports or high-speed rail stations.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Onion Model\u003c/h2\u003e \u003cp\u003eThe Onion Model is a multi-level competency framework that conceptualizes an individual\u0026rsquo;s capabilities as three progressive layers: the outermost Knowledge and Skills layer, the middle Behavioral Performance layer, and the innermost Intrinsic Attributes layer. This model uses the metaphorical layers of an onion to illustrate the deep structure of competence, emphasizing that capability extends beyond surface-level, visible knowledge and skills to include concrete behavioral applications, and is fundamentally driven by internal attributes such as values, motivation, and personality traits.\u003c/p\u003e \u003cp\u003eThe Knowledge and Skills layer encompasses explicit content like professional knowledge and operational skills, forming the foundational and observable aspect of competence. The Behavioral Performance layer reflects the application of this knowledge and skill in practical work settings, demonstrated through abilities like communication, adaptability, and teamwork. The core Intrinsic Attributes layer focuses on an individual's psychological characteristics and value systems, which serve as the fundamental drivers for competency development. This theory underscores the dynamic, integrated, and multidimensional nature of competence, making it suitable for assessment in complex environments and aiding in the holistic understanding and cultivation of an individual's comprehensive competency structure. Through this layered framework, the Onion Model provides a theoretical basis for the systematic analysis and continuous improvement of nursing competencies, facilitating the construction of a scientific and rational competency evaluation system and promoting standardized, refined management within the nursing profession.\u003c/p\u003e \u003cp\u003eTo construct an Onion Model-based core competency indicator system for airport emergency center nurses, an expert panel was formed, consisting of 17 experts: 2 held senior clinical nursing titles, 5 were engaged in clinical nursing practice, 4 in nursing management, 6 in clinical medicine, and 2 in administration. The final framework was developed through an evidence-based approach and Delphi expert consultation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Literature Review\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted in Chinese databases (CNKI, Wanfang Data, VIP) and English databases (Medline, PubMed, Web of Science). The search strategy employed keywords including \"onion model,\" \"airport emergency center,\" \"nursing,\" \"core competency,\" \"competence,\" \"indicator,\" and \"framework.\" The search period spanned from the inception of each database to February 2024. The inclusion criteria were: ① literature in Chinese or English; ② all publication types were considered. The exclusion criterion was: unavailability of the full text. Based on the findings of this literature review, a preliminary draft of the Onion Model-based core competency evaluation indicators for airport emergency center nurses was constructed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Expert Panel Meetings\u003c/h2\u003e \u003cp\u003eA research team of 10 experts reviewed the preliminary draft of the core competency indicators. Considering the unique clinical context of airports, the competency levels were restructured. For items in the draft that were contentious, Focus Group Discussions (FGDs) were organized. The \"Scenario Anchoring Method\" was employed, where experts provided modification suggestions based on real-world cases. Through a voting process, items with an agreement rate of \u0026ge;\u0026thinsp;90% were retained, ultimately finalizing the content of the core competency system.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Delphi Phase\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Delphi Technique Phase\u003c/h2\u003e \u003cp\u003eAccording to the standard requirements for expert selection in the Delphi technique, the panel typically comprises 15 to 50 individuals \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, who should possess extensive professional knowledge and practical experience in the relevant field. For this study, fifteen experts were selected.\u003c/p\u003e \u003cp\u003eThe criteria for expert inclusion were as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ebeing a healthcare professional engaged in work related to civilian airport emergency centers or familiar with the current status and development of the industry;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ehaving over 10 years of work experience in this field;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eholding an intermediate professional title or higher;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003evoluntarily agreeing to participate in the study. The exclusion criterion was the failure to return the consultation questionnaire in a timely manner during the research period.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Expert Questionnaire\u003c/h2\u003e \u003cp\u003eThe expert consultation questionnaire used in this phase consisted of four main sections: 1) the background, objectives, and research content of the study; 2) general demographic information of the experts; 3) the expert\u0026rsquo;s familiarity with the content of the survey and the basis for their evaluation of the items\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e; and 4) a request for experts to rate the importance of each indicator using a 5-point Likert scale, where a score of 1 indicated \u0026ldquo;not important\u0026rdquo; and 5 indicated \u0026ldquo;very important.\u0026rdquo; Experts were also invited to provide suggestions for adding, removing, or modifying items in the remarks section.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e2.4.3 Implementation of the Expert Consultation\u003c/h2\u003e \u003cp\u003eThe expert consultation was conducted in June 2025. Questionnaires were distributed to the selected experts, who were reminded to provide feedback in a timely manner. Two rounds of Delphi expert consultation were carried out. The process was concluded when a high degree of consensus among the experts was achieved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003e2.4.4Delphi Implementation\u003c/h2\u003e \u003cp\u003eTwo Delphi rounds were conducted via email from June to September 2025, each lasting two weeks. After Round 1, we revised materials based on expert feedback. Retention criteria required indicators to simultaneously satisfy: (1) mean importance score\u0026thinsp;\u0026gt;\u0026thinsp;3.5, (2) coefficient of variation\u0026thinsp;\u0026lt;\u0026thinsp;0.25, and (3) full-score proportion\u0026thinsp;\u0026gt;\u0026thinsp;20%.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Ethical Considerations\u003c/h2\u003e \u003cp\u003e This study was approved by the ethics board of Guangdong Second Provincial General Hospital (Approval ID: 2025-KY-SQ-160). All ethical considerations were conducted following the Helsinki Declaration. Participants received full study information before each Delphi phase. All provided written informed consent, acknowledging voluntary participation and unrestricted withdrawal rights. Data were anonymized using identification numbers, and all information from participants who withdrew was irreversibly destroyed. No personally identifiable data will appear in publications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Data Analysis\u003c/h2\u003e \u003cp\u003eData entry and statistical analysis were performed using IBM SPSS Statistics 25.0. General characteristics of the experts were described using frequencies, percentages (%), and mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The response rate of the questionnaires was used to represent the enthusiasm coefficient of the experts. The authority degree of the experts (Cr) was determined by the judgment coefficient (Ca) and familiarity coefficient (Cs) \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, The degree of consensus among the experts was assessed using Kendall\u0026rsquo;s coefficient of concordance (W) and the coefficient of variation (CV). In this study, the criteria for retaining indicators included a CV\u0026thinsp;\u0026lt;\u0026thinsp;0.25 and a mean score\u0026thinsp;\u0026ge;\u0026thinsp;3.5. Finally, the Analytic Hierarchy Process (AHP) was applied to determine the weights of indicators at all levels based on their importance ratings\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e。\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Expert Demographic Profile\u003c/h2\u003e \u003cp\u003eA total of 17 experts participated in this study. The demographic characteristics were as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAge: 9 were 30\u0026ndash;40 years old, 5 were 40\u0026ndash;50 years old, and 3 were over 50 years old.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGender: 13 females and 4 males.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProfessional title: 15 held intermediate-level titles and 2 held associate senior titles.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEducation level: 16 held bachelor\u0026rsquo;s degrees and 1 held a master\u0026rsquo;s degree.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eYears of experience: 2 had less than 10 years, 9 had 10\u0026ndash;20 years, and 6 had more than 20 years.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProfessional field: 6 were engaged in clinical medicine, 5 in clinical nursing, 4 in nursing management, and 2 in administrative management.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGeographical distribution: 3 from Northeast China, 1 from North China, 6 from East China, 3 from South China, 2 from Southwest China, and 2 from Northwest China.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Expert Response Rates and Authority Coefficient\u003c/h2\u003e \u003cp\u003eTwo rounds of expert consultation were conducted, with 17 questionnaires distributed in each round. All 17 experts returned completed questionnaires, resulting in a response rate of 100%. This indicates a high level of interest and active engagement among the experts in the research on core competencies for airport emergency nursing.\u003c/p\u003e \u003cp\u003eThe expert authority coefficient (Cr) was 0.8323, which consisted of a judgment coefficient (Ca) of 0.9235 and a familiarity coefficient (Cs) of 0.7412. These results demonstrate that the 17 experts possessed a high degree of authority and credibility in the field of airport emergency care.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Concentration and Coordination of Expert Opinions\u003c/h2\u003e \u003cp\u003eThe coefficient of variation (CV) and Kendall\u0026rsquo;s coefficient of concordance (W) were used to assess the degree of divergence among expert ratings for each indicator and to evaluate the reliability of each round of scoring. Kendall\u0026rsquo;s W reflects the level of agreement among the 16 participating experts regarding the weights assigned to indicators at each level. Because calculating Kendall\u0026rsquo;s W can be complex, it was computed using SPSS software. W values range between 0 and 1; higher values indicate better agreement among experts, while lower values indicate poorer agreement. A P-value of less than 0.05, corresponding to the W value, suggests that the experts' ratings of the indicator system were statistically consistent. The ranges of the coefficient of variation and Kendall\u0026rsquo;s W for indicators across levels, based on the two rounds of expert consultation, are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRange of coefficient of variation and coordination coefficient in the first round of expert consultation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient of Variation (CV)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKendall's W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi-square Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDegrees of Freedom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0-0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.593\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.068\u0026ndash;0.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.049\u0026ndash;0.258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e388.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRange of coefficient of variation and coordination coefficient in the second round of expert consultation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEvaluation Level\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient of Variation (CV)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKendall's W\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eChi-square Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDegrees of Freedom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP -value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.068\u0026ndash;0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecond-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0-0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e84.619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThird-level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0-0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e371.889\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe specific feedback from the first round of expert consultation indicated that indicators with a coefficient of variation (CV) greater than 0.25 were removed.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDeleted indicators\u003c/b\u003e: 1.4 Port infectious disease prevention and control; under aviation clinical medicine indicators \u0026mdash; 1.6.1 Understanding of health maintenance for flight personnel, and 1.6.2 Familiarity with common first aid and prevention measures for flight personnel.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eModified indicator\u003c/b\u003e: Indicator 1.1.4 \u0026ldquo;Assessment, judgment, and management of acute pain such as chest pain and abdominal pain\u0026rdquo; was revised to \u0026ldquo;Assessment, judgment, and management of acute pain\u0026rdquo;.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eAdded indicator\u003c/b\u003e: 1.1.8 Recognition and emergency management of chest pain and stroke.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAfter deliberation, the research team decided to approve the deletion of indicators 1.4, 1.6.1, and 1.6.2; the modification of indicator 1.1.4; and the addition of the new indicator.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn the second round of consultation, the Kendall\u0026rsquo;s W values for the indicators ranged from 0.413 to 0.509, which were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The consistency of expert opinions improved compared to the first round, indicating good inter-rater reliability. The specific Kendall\u0026rsquo;s W values are presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. No further modifications were suggested by the experts in this round. Following this, the research team held discussions based on the feedback from both Delphi rounds and finalized the indicator system. This resulted in 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. The detailed evaluation indicator scheme is shown in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Weighting Results\u003c/h2\u003e \u003cp\u003eBased on the expert consultation scores from the second round, the weights of the indicator system were determined. The first-level indicators were assigned the following weights: theoretical knowledge (0.489), professional skills (0.436), professional competence (0.082), and professional development (0.082). Detailed weights for the remaining levels of indicators are presented in Tables\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpert Consultation Results for First-Level Indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst-Level Indicator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoefficient of Variation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Theoretical knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Professional Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Professional Competence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.118\u0026thinsp;\u0026plusmn;\u0026thinsp;0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Professional Development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e4.118\u0026thinsp;\u0026plusmn;\u0026thinsp;0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExpert Consultation Results for Secondary Indicators\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Indicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eCoefficient of Variation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Care of Common Acute and Critical Illnesses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.647\u0026thinsp;\u0026plusmn;\u0026thinsp;0.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2\u0026nbsp;Transport of Critically Ill Patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Emergency Management and Response in Disaster Rescue and Public Health Emergencies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Occupational Protection Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5 Aviation Clinical Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1 Emergency Skills Proficiency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2 Emergency Skills for Disaster Rescue and Public Health Emergencies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.647\u0026thinsp;\u0026plusmn;\u0026thinsp;0.493\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3Management Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.706\u0026thinsp;\u0026plusmn;\u0026thinsp;0.920\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4 Communication and Coordination Skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1 Professional Ethics and Standards\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.866\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.667\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2 Professional Commitment and Affective Attributes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1Teaching and Instruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4.06\u0026thinsp;\u0026plusmn;\u0026thinsp;0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.750\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.2 Scientific Research\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e3.647\u0026thinsp;\u0026plusmn;\u0026thinsp;0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c7\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eExpert Consultation Results for Tertiary Indicators\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary Indicators\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;Standard Deviation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoefficient of Variation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eWeight\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.1 Knowledge of the etiology and mechanisms, clinical assessment and diagnosis, emergency care, and specialized nursing for common acute and critical conditions across various body systems.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.2 Knowledge of the etiology and mechanisms, clinical assessment and evaluation, emergency care, and specialized nursing for shock.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.3\u0026nbsp;Knowledge of the etiology and mechanisms, clinical assessment and evaluation, and emergency nursing care for trauma.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.167\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.4\u0026nbsp;Assessment, evaluation, and management of acute pain.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.294\u0026thinsp;\u0026plusmn;\u0026thinsp;0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.198\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.5\u0026nbsp;Knowledge of the etiology and mechanisms, clinical assessment and evaluation, emergency care, and specialized nursing for common acute and critical conditions in special populations (e.g., pregnant women, children).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.588\u0026thinsp;\u0026plusmn;\u0026thinsp;0.712\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.022\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.6\u0026nbsp;Emergency nursing care for acute poisoning and accidents.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.030\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.7\u0026nbsp;Knowledge of the actions, routes of administration, and reactions of common emergency medications.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.471\u0026thinsp;\u0026plusmn;\u0026thinsp;0.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1.8\u0026nbsp;Recognition and emergency management of chest pain and stroke.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.1\u0026nbsp;Knowledge of safe intra-hospital transport procedures for critically ill patients, handover content, and contraindications for transport.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2.2\u0026nbsp;Ability to correctly execute patient transport based on the patient's specific condition and clinical needs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.353\u0026thinsp;\u0026plusmn;\u0026thinsp;0.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.1\u0026nbsp;Familiarity with the activation process of the airport-specific mass casualty incident emergency response plan.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.2\u0026nbsp;Understanding of airport-specific triage scenarios: Ability to perform rapid, safe, and efficient mass casualty triage in complex airport environments (e.g., gates, runways, baggage claim areas), considering evacuation routes, safe zone establishment, and collaboration with fire services, security, and ground handling.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.706\u0026thinsp;\u0026plusmn;\u0026thinsp;0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.3\u0026nbsp;Familiarity with fundamental knowledge and skills in disaster nursing, including basic disaster concepts, essential disaster nursing knowledge, and principles of medical emergency response in disasters.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.562\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3.4\u0026nbsp;Awareness of potential legal and ethical issues nurses may encounter during rescue operations.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.1\u0026nbsp;Mastery of infection prevention and control knowledge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.193\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.2\u0026nbsp;Mastery of basic occupational protection knowledge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.706\u0026thinsp;\u0026plusmn;\u0026thinsp;0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.3\u0026nbsp;Mastery of standard precaution knowledge.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.588\u0026thinsp;\u0026plusmn;\u0026thinsp;0.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.578\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4.4\u0026nbsp;Mastery of post-exposure management procedures.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5.1\u0026nbsp;Familiarity with aviation physiology: Understanding the effects of barometric pressure changes (e.g., during takeoff/landing) on common medical conditions (e.g., pneumothorax, barotrauma, sinusitis, bowel gas expansion) and trauma, and their emergency management.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.647\u0026thinsp;\u0026plusmn;\u0026thinsp;0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5.2\u0026nbsp;Mastery of knowledge regarding the impact of the aircraft cabin environment (low humidity, low oxygen partial pressure, confined space, noise) on patient conditions and the specifics of performing medical interventions onboard.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.177\u0026thinsp;\u0026plusmn;\u0026thinsp;0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.1\u0026nbsp;Proficiency in basic/common emergency rescue techniques: Hemostasis, bandaging, immobilization, transport, etc.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.2\u0026nbsp;Proficiency in Basic Life Support (BLS) and Advanced Life Support (ALS).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.000\u0026thinsp;\u0026plusmn;\u0026thinsp;0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.302\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.3\u0026nbsp;Proficiency in insertion and maintenance techniques for commonly used medical tubes/lines.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.059\u0026thinsp;\u0026plusmn;\u0026thinsp;0.966\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.4\u0026nbsp;Proficiency in the operation and management of commonly used emergency equipment/devices.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1.5\u0026nbsp;Proficiency in confined space rescue: Ability to manage medical emergencies onboard an aircraft.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.199\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.1\u0026nbsp;Proficiency in triage techniques.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.2\u0026nbsp;Proficiency in nuclear, biological, and chemical (NBC) decontamination techniques.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.3\u0026nbsp;Proficiency in providing on-site emergency care in disaster settings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.343\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.4\u0026nbsp;Familiarity with psychological first aid for mass casualties: Ability to conduct initial psychological assessment and provide group psychological interventions for a large number of distressed passengers and crew.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.752\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2.5\u0026nbsp;Familiarity with disinfection and isolation procedures: Ability to perform isolation and decontamination for common and special infectious diseases.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.706\u0026thinsp;\u0026plusmn;\u0026thinsp;0.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.1\u0026nbsp;Familiarity with the organization and operation of emergency response teams.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.2\u0026nbsp;Mastery of occupational hazards and protection in nursing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3.3\u0026nbsp;Familiarity with the application of nursing-sensitive quality indicators and continuous quality improvement in airport emergency care.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.1\u0026nbsp;Cross-cultural communication competence and cultural sensitivity: Understanding health beliefs, pain expression, and preferences regarding medical decisions (e.g., informed consent processes, family roles) across different cultural backgrounds to avoid treatment delays or complaints due to cultural misunderstandings.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.2\u0026nbsp;Multilingual foundation: At least proficient in English, preferably with basic medical terminology in other commonly used languages. Ability to effectively use translation tools.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.883\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.3\u0026nbsp;Non-verbal communication: Ability to skillfully use clear gestures, pictures, etc., for effective communication when language is a barrier.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.059\u0026thinsp;\u0026plusmn;\u0026thinsp;0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.4\u0026nbsp;Emergency response and multi-agency coordination capability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.5\u0026nbsp;Resource coordination: Ability to coordinate medical resources both within and outside the airport within a short timeframe.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4.6\u0026nbsp;Diversion coordination: Ability to rapidly coordinate ground ambulance services, customs and border control, receiving hospitals, etc., to ensure seamless handover when a flight diverts to the local airport for medical reasons.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.1\u0026nbsp;Airline agreements: Understanding specific protocols and processes of different airlines regarding medical incident handling and cost responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.210\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.166\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.2\u0026nbsp;Civil aviation regulations: Familiarity with international and national civil aviation regulations related to aviation medicine.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.647\u0026thinsp;\u0026plusmn;\u0026thinsp;0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.3\u0026nbsp;Mandatory reporting: Mastery of mandatory reporting procedures and designated recipients for specific incidents (e.g., those involving aviation safety, infectious diseases, fatalities, certain special diseases).\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.706\u0026thinsp;\u0026plusmn;\u0026thinsp;0.849\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.1.4\u0026nbsp;Mastery of airport emergency center work regulations, job responsibilities, and operational procedures.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.1\u0026nbsp;Possession of professional integrity and a spirit of dedication.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.177\u0026thinsp;\u0026plusmn;\u0026thinsp;0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.2\u0026nbsp;Humanistic care: Ability to conduct nursing practice in accordance with relevant laws, regulations, and ethical requirements. Respecting patient rights and protecting patient privacy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.118\u0026thinsp;\u0026plusmn;\u0026thinsp;0.928\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.2.3\u0026nbsp;Strong sense of responsibility, demonstrating initiative in assuming duties.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1.1\u0026nbsp;Advanced training and continuing education.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.765\u0026thinsp;\u0026plusmn;\u0026thinsp;0.437\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.278\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1.2\u0026nbsp;Instructional design ability: Mastery of various theoretical teaching methods and multimedia production skills.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.177\u0026thinsp;\u0026plusmn;\u0026thinsp;0.728\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1.3\u0026nbsp;Specialized study.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.529\u0026thinsp;\u0026plusmn;\u0026thinsp;0.717\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.175\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1.4\u0026nbsp;Clinical teaching and preceptorship ability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.412\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.1.5\u0026nbsp;Self-directed learning ability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.2.1\u0026nbsp;Clinical research capability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.941\u0026thinsp;\u0026plusmn;\u0026thinsp;0.243\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.2.2\u0026nbsp;Knowledge and practical ability in evidence-based nursing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.824\u0026thinsp;\u0026plusmn;\u0026thinsp;0.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.2.3\u0026nbsp;Patent development capability.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.882\u0026thinsp;\u0026plusmn;\u0026thinsp;0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Scientificity and Innovativeness of the Indicator System Construction\u003c/h2\u003e \u003cp\u003eThe Delphi method employed in this study is a well-established approach widely used in similar research contexts. The reliability of its results is generally evaluated based on three aspects: expert authority, expert consensus, and participation rate. These aspects were selected because they collectively reflect the expertise, agreement, and engagement of the expert panel. In this study, the overall response rate across both rounds of consultation was 100%, indicating a high level of participation. The expert authority coefficient, which measures the expertise level of the panel, was 0.8323 for both rounds\u0026mdash;exceeding the threshold of 0.700. This high coefficient supports the reliability of the findings. The coefficients of variation (CV), which indicate the degree of dispersion in expert ratings, ranged from 0 to 0.258 in the first round and 0 to 0.248 in the second round. Additionally, Kendall\u0026rsquo;s W values for the different indicator levels ranged from 0.413 to 0.509, demonstrating a high degree of consensus and stability in expert opinions. These results further affirm the reliability of the study outcomes.\u003c/p\u003e \u003cp\u003eThe Onion Theory is a framework designed to analyze and improve core competencies in nursing professionals. It conceptualizes competencies across four layers: knowledge, skills, attitudes, and behaviors\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The knowledge layer emphasizes theoretical and medical expertise; the skills layer focuses on clinical operational capabilities; the attitude layer addresses professional values and ethics; and the behavior layer assesses workplace performance. The Onion Theory\u0026rsquo;s hierarchical structure represents a progressive model that provides a clear pathway to develop nursing competencies and improve nursing quality. Its systematic design accommodates complex operational environments and incorporates dynamic adjustment mechanisms to adapt to contextual changes. In the specific setting of airport emergency care, the theory facilitates the enhancement of cross-cultural communication skills, emergency decision-making abilities, and teamwork cohesion, thereby contributing to more efficient emergency response and strengthened collaborative performance\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Its innovative application highlights the multidimensional and adaptive nature of nursing competency frameworks. Particularly in culturally diverse environments such as airports, nursing staff can improve their communication competence by understanding varying cultural perspectives on medical services and health, thereby reducing potential misunderstandings and conflicts. Furthermore, through strengthened emergency decision-making and team collaboration\u0026mdash;supported by simulation training and team exercises\u0026mdash;nursing personnel demonstrate significantly improved performance under high-pressure conditions and greater teamwork efficiency\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Practicality and Replicability of the Constructed Indicator System\u003c/h2\u003e \u003cp\u003eThis study developed a core competency indicator system for nursing in airport emergency centers based on the \"Onion Theory.\" The system is characterized by high practicality and broad replicability. These attributes ensure the system provides clear guidance for capacity building in airport emergency centers and serves as a valuable reference for medical security systems in similar facilities. Regarding practicality, the system demonstrates a high degree of contextual fit. Its construction strictly adhered to the \"from surface to core\" logic of the Onion Theory and was closely integrated with the distinctive environment of airports. This includes responding to mass casualty incidents, managing various injuries and illnesses, operating under intense time pressure, and collaborating across multiple departments. Consequently, each indicator directly addresses core needs in real-world operational contexts. For instance, indicators like \"Knowledge of Aviation Medical Emergency Management\" and \"Inter-departmental (e.g., Security, Ground Services) Collaborative Emergency Response Capability\" represent critical elements that distinguish airport emergency care from conventional pre-hospital or in-hospital emergency care. This approach aligns with the study by Kyong Hee Park et al\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e, which identified and integrated nurses' core competencies across multiple roles and responsibilities through systematic review and network analysis, optimizing the indicator structure to fit specific nursing contexts.\u003c/p\u003e \u003cp\u003eIn terms of structure and operability, the hierarchical \"onion\" framework provides a clear pathway for competency assessment and development\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. Managers can utilize indicators from the \"Knowledge and Skills Layer\" for initial competency screening and standardized training. Indicators from the \"Ability Layer\" (e.g., on-site decision-making, adaptability) can inform the design of advanced drills and scenario simulations. Meanwhile, the \"Attitude and Values Layer\" (e.g., humanitarian care, team collaboration spirit) offers value-based guidance for organizational culture development and staff motivation. This stratified logic facilitates the targeted allocation of resources, development of training programs, and establishment of performance evaluation criteria. The foundational layer primarily encompasses general emergency care competencies, including Basic Life Support (BLS) and Advanced Life Support (ALS) skills. These are essential capabilities for all emergency nursing personnel \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e.This layered capacity-building model supports the comprehensive enhancement of the integrated emergency response capabilities of airport emergency nurses, thereby increasing their adaptability and responsiveness within the complex and dynamic airport emergency environment \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Limitations","content":"\u003cp\u003eSeveral limitations should be considered when interpreting the findings of this study. First, the expert panel, while demonstrating high authority and engagement, was primarily composed of professionals from specific regions and institutional backgrounds. Consequently, the incorporated perspectives may reflect context-specific factors, potentially affecting the generalizability of the competency framework across different healthcare systems or cultural settings. Second, the construction of the competency framework relied on the Delphi method and the theoretical structure of the Onion Model. Although rigorous, this process is inherently subjective and consensus-based, and the resulting indicators may be influenced by the panel's collective viewpoint rather than solely by empirical evidence. Third, this study presents a theoretical framework whose practical effectiveness, impact on training outcomes, and applicability in real-world airport emergency scenarios have not yet been empirically validated. Implementation or longitudinal assessment is needed to confirm these aspects. Finally, the framework focuses on core competencies from a nursing perspective and may not fully encompass all interdisciplinary collaborative skills required in complex airport emergency responses, such as coordination with aviation security, ground operations, and external emergency services. Future research should aim to apply and test this framework in diverse clinical and operational settings, to validate, refine, and expand its components.\u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003eThis study constructed a core competency indicator system for nursing staff in airport emergency centers using the Delphi method. The system comprises 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. The developed system demonstrates scientific rigor and practical applicability, as it is based on a methodologically sound approach and a comprehensive, rational indicator framework. These findings provide a scientific basis for developing targeted emergency training programs for nursing personnel in airport emergency centers. However, the selection of experts may have introduced regional biases, which represents a potential limitation of this study. Therefore, future research should focus on practical application and validation to further refine and improve the proposed framework.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e6.1 AUTHOR CONTRIBUTIONS\u003c/strong\u003e\u003cbr\u003e\u003cstrong\u003eGuarantor of integrity:\u003c/strong\u003e\u0026nbsp; Chongming Huang, Kunlong Deng\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eStudy conception:\u003c/strong\u003e\u0026nbsp; Linna Yu\u003cbr\u003e\u003cstrong\u003eLiterature review:\u003c/strong\u003e\u0026nbsp; Xuemei Chen, Na Tang\u0026nbsp;\u003cbr\u003e\u003cstrong\u003eData collection:\u003c/strong\u003e\u0026nbsp; Chongming Huang, Xuemei Chen\u003cbr\u003e\u003cstrong\u003eData analysis:\u003c/strong\u003e\u0026nbsp; Kunlong Deng, Jiaxin Liu\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis:\u003c/strong\u003e\u0026nbsp; Chongming Huang\u003cbr\u003e\u003cstrong\u003eManuscript drafting:\u003c/strong\u003e\u0026nbsp; Chongming Huang\u003cbr\u003e\u003cstrong\u003eManuscript revision:\u003c/strong\u003e\u0026nbsp; Linan Yu\u003cbr\u003e\u003cstrong\u003eManuscript approval:\u003c/strong\u003e Kunlong Deng\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.2 FUNDING\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Guangdong Provincial Medical Science and Technology Research Foundation (Grant No. C2025051).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.3 Data availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.4\u0026nbsp;Acknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to all the expert panel members who contributed their time and expertise to this Delphi study. We also extend our appreciation to the participating nurses and institutions for their valuable input and support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.5 Consent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.6 CONFLICT OF INTEREST STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6.7 ETHICS STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the ethics board of Guangdong Second Provincial General Hospital (Approval No. 2025-KY-SQ-160; Date: June 30, 2025). All ethical considerations were conducted following the Helsinki Declaration. All participants received written documentation outlining the research objectives and methodology prior to participating in the Delphi study. Voluntary participation was confirmed through signed informed consent forms. Participants were explicitly informed of their right to withdraw at any stage. All data were anonymized using unique identification codes, with personal information of non-participants immediately deleted. Any public reporting of results guarantees non-identifiability of individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7 STUDY STATEMENT\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has completed the construction of core competency indicators for nursing staff in airport emergency centers based on the Onion Model.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eASANO MAKINOT, TAKUHIRO Y. International airport and emergency medical care [J]. J Nippon Med School = Nippon Ika Daigaku zasshi. 2002;69(2):185\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDOVE, D B, DEL GUERCIO L R, STAHL W M, et al. A metropolitan airport disaster plan\u0026ndash;coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation [J]. J trauma. 1982;22(7):550\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJing CC, Xing Q, Wei LL, et al. Construction of an evaluation index system for trauma care competency of emergency specialist nurses. Chin J Clin Nurs. 2024;16(6):362\u0026ndash;366372.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTian Y, He TT, Yang MF, et al. Research on construction method of post competency model for ICU specialist nurses. Chin J Integr Tradit West Med Intensive Crit Care. 2018;25(4):408\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCHEN, Y C. [Essential professional core competencies for nurses] [J]. Hu li za zhi J Nurs. 2010;57(5):12\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMCLANE. A M. Core competencies of masters-prepared nurses [J]. Nurs Res. 1978;27(1):48\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTOMCZYK B CALDERS, CUSSEN M E, et al. A Framework for Standardizing Emergency Nursing Education and Training Across a Regional Health Care System: Programming, Planning, and Development via International Collaboration [J]. J Emerg Nurs. 2022;48(1):104\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen WW, Chen L, Fan RJ, et al. Construction of competency index system for flight nurses in air rescue. Chin Nurs Res. 2022;36(4):600\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao Z, Liu HJ, Xie YX, et al. Construction of core knowledge system for flight nurses' air ambulance service. Chin Nurs Manag. 2020;20(5):676\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang XX, He LX, Zhang L, et al. Investigation on first aid knowledge, attitude, practice and training needs among airport staff. Chin Nurs Manag. 2015;15(12):1449\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Cui XM. Construction of an evaluation index system for independent duty qualification of newly recruited nurses in obstetrics department of tertiary hospitals based on Onion Model. J Nurs. 2024;31(21):32\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDing JF, Tan LF, Tang ZX, et al. Delphi method and its application in public health: current status and prospects. J Environ Occup Med. 2012;29(11):727\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi YY, Chen WJ. Application status of Delphi method in nursing management. Chin Nurs Res. 2018;32(21):3339\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang SN, Dong R, Xie H, et al. Application progress of Delphi method in constructing indicator systems. J Bengbu Med Coll. 2016;41(5):695\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGong WY. Construction and predictive effect analysis of postpartum venous thromboembolism risk assessment scale based on Delphi-AHP method [Dissertation]. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang X, Wang XM. Construction of competency evaluation index system for nurses responding to public health emergencies in tertiary hospitals based on Onion Model. Gen J Nurs. 2025;23(12):2342\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHEKHAR, A C, RUSKIN K J. Sudden cardiac arrest in commercial airports: Incidence, responses, and implications [J]. Am J Emerg Med. 2022;59:118\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eD'ASTA F, HOMSI J, SFORZI I, et al. SIMBurns: A high-fidelity simulation program in emergency burn management developed through international collaboration [J]. Burns: J Int Soc Burn Injuries. 2019;45(1):120\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePARK K H KIMHR. Mapping Nursing Roles in Long-Term Care: A Systematic Review With Network Analysis [J]. Journal of advanced nursing; 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLI CHENF, LI L et al. J,. Development of Infectious Disease Emergency Response Competencies for Nurses in China: A Delphi Study and an Analytic Hierarchy Process [J]. Journal of nursing management, 2023, 2023: 9952280.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eADELGAIS LYNGJ, ALTER K. Recommended Essential Equipment for Basic Life Support and Advanced Life Support Ground Ambulances 2020: A Joint Position Statement [J]. Prehospital Emerg care. 2021;25(3):451\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJIANG TAOY, LI X. An Evaluation Index System for Core Competencies of Specialist Nurses in Pediatric Emergency Care [J]. Am J Health Behav. 2023;47(2):217\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Onion Model, Airport Emergency Center, Core Competency of Nurses, Indicator System, Delphi Method","lastPublishedDoi":"10.21203/rs.3.rs-8621894/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8621894/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eIntroduction\u003c/b\u003e: Airports, as critical transportation hubs, present unique medical emergency scenarios characterized by high unpredictability, diverse and complex disease profiles, and a demand for multi-departmental coordination. These conditions impose specialized requirements on the core competencies of nursing staff in airport emergency centers. However, current research has predominantly focused on emergency care skills within hospital settings, resulting in a significant gap in the evaluation system for nursing competencies specifically tailored to international airport emergency contexts. Existing training and assessment programs often lack systematic and tiered competency indicators, leading to insufficiently targeted training content and difficulties in evaluating outcomes. Therefore, this study aims to develop a scientific, systematic, and measurable core competency indicator framework for nursing staff in airport emergency centers based on the Onion Model, to address the absence of standardized assessment tools in this field.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethod\u003c/b\u003e: Based on a comprehensive literature review, we developed a preliminary set of core competency indicators for airport emergency center nursing according to the Onion Model. Subsequently, 17 experts participated in a two-round Delphi survey between June and December 2025 to refine and finalize the indicators and their respective weights.\u003c/p\u003e \u003cp\u003e \u003cb\u003eData\u003c/b\u003e: The study data primarily included:\u003c/p\u003e \u003cp\u003e\u0026bull; Quantitative rating data (using a 5-point Likert scale) and qualitative feedback from the two rounds of Delphi expert consultations.\u003c/p\u003e \u003cp\u003e\u0026bull; Pairwise comparison matrix data required for the Analytic Hierarchy Process (AHP).\u003c/p\u003e \u003cp\u003e\u0026bull; Statistical data for calculating expert engagement rate, authority index, consensus level, and degree of coordination, to validate the reliability of the methodology and the effectiveness of the results.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The response rate for the questionnaires was 100% in both Delphi rounds. The expert authority index reached 0.832, and Kendall\u0026rsquo;s coordination coefficients were 0.509, 0.415, and 0.413 across different levels (P\u0026thinsp;\u0026lt;\u0026thinsp;0.005). Based on the Onion Model, the finalized core competency indicators for nursing in airport emergency centers comprised 4 first-level indicators, 13 second-level indicators, and 56 third-level indicators. This study established a scientific and reliable competency indicator framework, providing a theoretical reference for training nursing staff in airport emergency centers.\u003c/p\u003e \u003cp\u003e \u003cb\u003eImplication\u003c/b\u003e: This study innovatively applies the Onion Model to the specific context of emergency nursing, providing a theoretical framework and empirical evidence for understanding and analyzing nursing competency structures in specialized settings. It enriches research on nursing competency models. The developed indicator system can be directly applied to the recruitment, selection, targeted training curriculum design, performance assessment, and career development guidance of nursing staff in airport emergency centers.\u003c/p\u003e","manuscriptTitle":"Empowering Airport Emergency Response: Developing a Core Competency Framework for Nursing Staff in Airport Emergency Centers Based on the Onion Model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-06 14:26:34","doi":"10.21203/rs.3.rs-8621894/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-18T05:18:58+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-16T09:40:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"320688420253140850930890200858753868393","date":"2026-02-04T11:55:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T20:00:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-03T18:49:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"277676939637327409441617768896873391295","date":"2026-02-03T18:39:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117912933017707416854673338448329831471","date":"2026-02-03T16:18:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-03T15:39:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-29T15:48:39+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-22T02:34:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-22T02:33:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2026-01-16T19:43:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd52003d-bba0-47e1-82f1-efc05df5cd73","owner":[],"postedDate":"February 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-13T16:03:47+00:00","versionOfRecord":{"articleIdentity":"rs-8621894","link":"https://doi.org/10.1186/s12909-026-09172-0","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2026-04-10 15:57:48","publishedOnDateReadable":"April 10th, 2026"},"versionCreatedAt":"2026-02-06 14:26:34","video":"","vorDoi":"10.1186/s12909-026-09172-0","vorDoiUrl":"https://doi.org/10.1186/s12909-026-09172-0","workflowStages":[]},"version":"v1","identity":"rs-8621894","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8621894","identity":"rs-8621894","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}